ScienceDaily (Mar. 4, 2011) — Researchers have for decades hypothesized that negative emotions lead to inflated reports of common physical symptoms, like headaches or an upset stomach. but a new University of Iowa study suggests that two negative emotions — depression and anxiety — influence symptom reporting in different ways.

Published in the latest issue of the Journal of Personality and Social Psychology, the study indicates that people who feel depressed report experiencing a higher number of past symptoms. People who feel anxious, by contrast, report more symptoms in the present moment.

Understanding how factors such as mood influence symptom reporting is important because physicians make diagnosis and treatment decisions based on the symptoms patients report, how intense they are, and how frequently they occurred, said study author Jerry Suls, a professor of psychology in the UI College of Liberal Arts and Sciences and a visiting scientist at the National Cancer Institute in Washington, D.C.

Previous studies have linked inflated symptom reports to "negative affect," a disposition also known as neuroticism. One-fifth of the population is believed to have this general tendency, which involves frequent feelings of anger, anxiety, fear, irritation or sadness. however, when the UI researchers examined the influence of temperament on symptom recall, they isolated each emotion rather than lumping them together.

"our data suggest that a person who walks into a physician’s office feeling sad will tend to recall experiencing more symptoms than they probably really did," Suls said. "if a person comes into the physician’s office feeling fearful, they’re more likely to scan their body and read any sensations they’re experiencing at that moment as something wrong. We believe this is because depression is associated with rumination and exaggerated recall of negative experiences, while anxiety is associated with vigilance for potentially negative things in the present time."

Suls co-authored the study with Bryant Howren, a post-doctoral scholar in the UI Department of Psychology and the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Veterans Affairs Medical Center in Iowa City.

In the first part of the study, 144 undergraduate students completed questionnaires to assess their level of "depressive affect," and indicated which of 15 common physical symptoms they’d experienced in the past three weeks. Even after factoring out physical signs of depression, like appetite changes or sleep loss, researchers found that people who felt more depressed believed they had experienced more symptoms.

"is it possible they actually did experience more symptoms? sure," Suls said. "but all of these folks were nominally healthy. It’s likely that each one experienced roughly the same number in terms of actual symptoms, but those who happened to be feeling blue thought they had experienced more."

Another phase of the study examined current symptom reporting. a sample of 125 undergraduates were assigned to groups. To induce a specific mood, each group wrote in detail for 15 minutes about an experience that made them feel angry, anxious, depressed, happy or neutral. They then completed a checklist to indicate which of 24 symptoms (weakness/fatigue, cardiorespiratory, musculoskeletal, and gastrointestinal) they currently felt. Participants in the anxious mood category reported higher numbers of physical symptoms.

"People could say, ‘Well, you made them anxious — isn’t that going to produce a physiologic reaction, like a pounding heart or sweaty palms?’" Suls said. "but we observed a general increase in all current physical symptoms — fatigue, for example, which isn’t typically a consequence of feeling fearful or nervous."

Researchers repeated the writing exercise with another group of 120 students — only this time they asked participants to report both current and retrospective symptoms. On average, people in the anxious group reported five current symptoms, while those in the depressed and neutral groups only reported one or two. Reflecting on the past three weeks, the sad participants reported experiencing seven symptoms on average, while the other groups only recalled about three.

"making people feel sad didn’t influence what they reported feeling at the moment, but it was associated with reporting having had more symptoms in the recent past," Suls said. "With anxiety, we saw exactly the opposite. They didn’t report more symptoms over the past three weeks, but at the moment they reported more."

Suls and Howren aren’t encouraging health care providers to discount symptoms by virtue of the patient’s mood. They do, however, encourage medical professionals to be aware that different emotions appear to play into how patients perceive their current and past symptoms.

"Ideally, a doctor would engage with the patient briefly to get a sense whether they’re experiencing anxiety or sadness at the time of the visit," Suls said. "In some cases, it may be worthwhile to ask a significant other what they’ve observed in terms of symptoms, or to ask the patient to keep a symptom diary to ensure accuracy."

The age of participants was a limitation of the study, though the authors intentionally chose healthy college students to reduce confounds. Other studies indicate that emotional instability (such as depressed or anxious moods) decreases around age 40, so older adults may be less subject to recall or encoding biases associated with physical symptoms. Suls and Howren will focus future symptom-reporting research on older or chronically ill adults.

The research was supported in part by a National Institute on Aging grant awarded to Suls and a post-doctoral fellowship from the VA awarded to Howren.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Iowa Health Care.

Journal Reference:

1. M. Bryant Howren, Jerry Suls. The symptom perception hypothesis revised: Depression and anxiety play different roles in concurrent and retrospective physical symptom reporting.. Journal of Personality and Social Psychology, 2011; 100 (1): 182 DOI: 10.1037/a0021715

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ScienceDaily (Feb. 24, 2011) — Family doctors can take more than a month to record ovarian cancer, once diagnosed by a specialist, in one in 10 cases, indicates research published in the launch issue of the new online journal BMJ Open.

Ovarian cancer was also incorrectly or prematurely classified in 11% of cases, the data show.

The authors base their findings on the "free text" data available in patient records, which are submitted to the General Practice Research Database (GPRD).

The GPRD contains long term anonymised medical data on more than four million patients on the lists of a representative 500 primary care practices across the UK.

The information, which is created during the course of GP consultations or correspondence relating to specialist referrals and diagnostic tests, is widely used for studies on aspects of disease and drug safety.

The authors focused on the Read codes relating to a diagnosis of ovarian cancer in women aged 40 to 80, between 2002 and 2007.

Read codes are used to code symptoms and diagnoses electronically in primary care in the UK. They provide the option to enter free text for each code, such as a letter from the specialist and a date when the ‘event’ occurred.

The authors also looked at this free text information to establish the time lag between when the specialist notified the GP of the diagnosis and the date it was officially coded as such in the patient’s record.

There is a good deal of free text in the database, but it is not always coded by GPs nor accessed by researchers, say the authors.

During the study period, 344 women were given one of three Read codes indicating a diagnosis of ovarian cancer.

Most cases (90%) had free text relating to ovarian disease, and in almost two thirds (64%) this confirmed a diagnosis of ovarian cancer.

But in one in five cases (22%) free text information confirmed this diagnosis before it was officially coded as such in the patient’s record. in one in 10 cases more than four weeks had elapsed.

The free text information also showed that mistakes been made in 11% of the records.

Four cases coded for ovarian cancer did not have the disease at all; in another six cases the cancer was a recurrence which was not evident in the coding. and in 35 cases, patients had been coded before a definitive diagnosis had been made

"for diseases which rely on hospital consultants for diagnosis, free text (particularly letters) is invaluable for accurate dating of diagnosis and referrals and also for identifying misclassified cases," conclude the authors.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.

Journal Reference:

1. A Rosemary Tate, Alexander G R Martin, Aishath Ali, Jackie Cassell. Using free text information to explore how and when GPs code a diagnosis of ovarian cancer: an observational study using primary care records of patients with ovarian cancer. BMJ Open, 23 February 2011 DOI: 10.1136/bmjopen-2010-000025

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ScienceDaily (Feb. 9, 2011) — Blocking a factor that can activate the human immune response against intestinal bacteria or certain foods could prevent the development of celiac disease in those most at risk, researchers report in the journal Nature.

The study, to be published early online Feb. 9, points to two chemical signals — interleukin 15 and retinoic acid, a derivative of vitamin a — as triggers for the inflammatory response to gluten, a protein found in many grains that causes celiac disease.

"We found that having elevated levels of IL-15 in the gut could initiate all the early stages of celiac disease in those who were genetically susceptible, and that blocking IL-15 could prevent the disease in our mouse model," said Bana Jabri, MD, PhD, associate professor of medicine and pathology, co-director of the Digestive Disease Research Core Center and a member of the Celiac Disease Center and Comprehensive Cancer Center at the University of Chicago.

"It also demonstrated that in the treatment of inflammatory intestinal diseases, vitamin a and its retinoic acid metabolites are likely to do more harm than good," she said.

"in a stressed intestinal environment," the authors note, "retinoic acid, which was thought to lessen inflammation in the intestine, acted as an adjuvant that promoted rather than prevented inflammatory cellular and humoral responses to fed antigen."

This pro-inflammatory effect in a stressed intestine may also help explain the connections between Accutane–a vitamin a metabolite given for the treatment of severe acne–and the onset of inflammatory bowel disease.

Celiac disease is a digestive disorder triggered by the protein gluten, found in wheat, barley and rye. The disease affects about one out of 100 people. Gluten can trigger an autoimmune reaction in the intestines of genetically susceptible people. this prevents the proper absorption of food and nutrients, and causes a variety of gastrointestinal and extra-intestinal symptoms.

The current treatment for celiac disease is a gluten-free diet. However, many patients, in particular adults, improve only partially on a gluten-free-diet. this diet is difficult to follow, costly and inconvenient. there is a growing interest in finding alternative therapies, such as a vaccine that could prevent disease development in genetically susceptible individuals.

Celiac disease is also associated with autoimmune disorders such as type-1 diabetes and autoimmune thyroiditis. Understanding celiac disease may speed the development of new therapies for these autoimmune disorders.

For this study, Jabri and colleagues combined insights and data from celiac disease patients, who had been cared for at the University of Chicago’s Celiac Disease Center, with experiments using a mouse model of the disease, developed in her lab.

Moving back and forth between "human data, where we develop our ideas, and mouse experiments, where we test them," was extremely helpful, said Jabri. "in turn, the mouse model gave us insights into the human disease."

They knew that many patients with this disease had high levels of Interleukin 15 in their intestines. when the researchers increased the levels of this signaling molecule in mouse intestine, the mice developed all the early symptoms of celiac disease. Adding retinoic acid to the mix only made the symptoms worse.

When they blocked IL-15, however, the diseased mice reverted to normal, and were once again able to tolerate gluten.

Clinical trials of medications that block IL-15 are already underway for patients with rheumatoid arthritis, another inflammatory disorder. Early results, have been encouraging. Blocking IL-15 or IL-15 signaling may be a way to restore oral tolerance to gluten and allow effective responses to vaccines aiming at preventing development of celiac disease, Jabri said.

This study is the first to identify an abnormal pathway leading to loss of tolerance to dietary antigens. It suggests that a "dysregulated intestinal environment may be the underlying cause for food allergies," Jabri said. what type of dyregulation is responsible for food allergies, such as to peanuts, is not yet known.

Although the IL-15 plus retinoic acid combination leads to inflammation and tissue damage in those at risk for celiac disease, the authors suggest that for those who, for genetic reasons, are less susceptible, the same combination could help enhance vaccines against several bacterial infections that cause diarrheal diseases. Children in developing countries often lack vitamin a. but by vaccinating them with selected bacterial proteins plus vitamin a, instead of using live viruses, they may be able to reduce the risks and increase the protective response.

The Digestive Disease Research Core Center at the University of Chicago, the Crohn’s and Colitis Foundation, and the National Institutes of Health funded this research. Additional authors include R.W. DePaolo, V. Abadie, F. Tang, H. Felhner-Peach, W. Wang, C. Semrad, S. Kupfer, and S. Guandalini of the University of Chicago; J.a. Hall and Y. Belkaid of the NIAID; E.V. Marietta and J.a. Murray of the Mayo Clinic College of Medicine; D.D. Kasarda of the U.S. Department of Agriculture; AND T.a. Waldman of the National Cancer Institute.

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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Chicago Medical Center, via EurekAlert!, a service of AAAS.

Journal Reference:

1. R. W. DePaolo, V. Abadie, F. Tang, H. Fehlner-Peach, J. a. Hall, W. Wang, E. V. Marietta, D. D. Kasarda, T. a. Waldmann, J. a. Murray, C. Semrad, S. S. Kupfer, Y. Belkaid, S. Guandalini, B. Jabri. Co-adjuvant effects of retinoic acid and IL-15 induce inflammatory immunity to dietary antigens. Nature, 2011; DOI: 10.1038/nature09849

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Disclaimer: this article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.